类风湿关节炎患者并发骨质疏松的临床研究

The clinical study of the rheumatoid arthritis patients combined with osteoporosis

目的探讨类风湿关节炎(RA)患者骨密度(BMD)的变化和骨质疏松(OP)的发生情况及其与临床指标的相关性。方法 采用双能X线骨密度仪,测量了105例RA患者的腰椎和股骨颈的骨矿含量,并同时测定关节功能、X线分期、关节压痛数和肿胀数、C反应蛋白(CRP)、抗链球菌溶血素"O"(ASO)、血清类风湿因子(RF)、血沉(ESR)、抗瓜氨酸肽抗体(CCP)、血钙、磷、碱性磷酸酶等指标。结果105例RA患者中骨质疏松的发生率是47%,RA患者中OP组与非OP组比较在年龄(P<0.001),病程(P<0.01),ESR(P<0.05),Ca(P<0.05),AKP(P<0.01),关节功能(P<0.05)均具有显著差异,关节压痛数和肿胀数及RF、CRP、CCP、P、ASO、X线分期等指标比较无差异。RA患者中激素组与非激素组间发生率的比较差异有显著性(X2=11.021,OR=4.189,P=0.001)。股骨颈与腰椎BMD比较显示激素组与非激素组间均具有明显差异(P<0.01)。激素使用小剂量组OP发生较非小剂量组多(P<0.01),激素长时间用药组较短时间用药组的OP发生多(P<0.01)。RA患者中免疫抑制剂组与非免疫抑制剂组间引起OP的比较无差异(X2=0.536 OR=1.333,P=0.464)。结论 确诊为RA的患者应进行BMD检测,以了解骨矿含量,在RA治疗过程中需早期发现、早期预防骨质疏松的发生。

Objective To study the changes of bone mineral density （BMD） and the prevalence of osteoporosis （OP） in patients with rheumatoid arthritis （ RA）, and their clinical correlations. Methods BMDs of the lumbar spine and the femural neck of 105 RA patients were measured using DXA. Joint functional status, X-ray status, the number of tender or swollen joints, C-reactive protein （CRP） , anti- streptolysin 0 test （ASO）, serum rheumatoid factor （RF）, erythrocyte sedimentation rate （ESR）, cyclic citrullinated peptides （ CCP）, blood calcium （Ca） and phosphorus （P） , and alkaline phosphatase （AKP） , were measured simultaneously. Results The incident rate of osteoporosis in 105 RA patients was 47%. There were significant differences between OP and non-OP group in terms of age （ P 〈 0. 001 ） , course of the disease （ P 〈 0. 01 ） , ESR （P 〈 0.05）, Ca （P 〈 0. 05 ） , AKP （ P 〈 0. 01 ） , and the joint functional status （ P 〈 0. 05 ）. There were no significant differences in the number of tenderness and swollen joint, RF, CRP, CCP, P, ASO, and X-ray staging. There was significant difference in the incident rate （X2 = 11,021, OR = 4. 189, P = 0. 001 ）, lumbar spine and femur neck BMDs （ P 〈 0.01 ） between the glucocorticoid and non-glucocorticoid group of RA patients. The incident rate of OP in the small-dose g＇tucocorticoid group was higher than that in non-small-dose glucocorticoid group （P 〈 0.01 ）. The incident rate of OP in the long - term use group was higher than that in short-term use group （P 〈0. 01 ）. There was no significant difference between the immunosuppressant group and the non-immunosuppressant group in terms of the incident rate of OP （X2 = 0. 536, OR = 1. 333, P = 0. 464 ）. Conclusion BMD testing should be performed in patients diagnosed with RA, in order to learn the bone mineral content in the patients. Osteoporosis should be early detected and prevented during the treatment of RA.